Serna González CV, de Carvalho VF, Park Kim SH
… +5 more, Bandeira da Silva CV, Dos Santos Amaral AF, Lima Villela de Castro D, Nogueira PC, de Gouveia Santos VLC
The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, obs...The objective of this study was to identify the occurrence of complicated surgical wounds (CSWs) and to analyze the associated factors in hospitalized patients at an oncology institution. This was an epidemiological, observational, cross-sectional, descriptive, and correlational study conducted in the intensive care and hospitalization units forming part of a large cancer hospital. Sociodemographic and clinical data were collected from medical records and physical examinations of the skin. Associations between the dependent variable (presence of CSWs) and the independent variables were obtained by chi-square tests and odds ratio (OR) calculations with a 95% confidence interval. Logistic regression (LASSO) was used to verify the possible predictors of the outcome. The sample consisted of 341 patients, specifically individuals who are White (46.9%), married (53.4%), and men (58.1%) with an average age of 59.2 years. Complicated surgical wounds were present in 3.2% of patients, and the most frequent types of complications were dehiscence (40%), infection (26.7%), and fistula (20%) present in the abdominal (40%), cephalic (26.7%), and cervical (13.3%) regions. Senile purpura, diaper use, and infection were the clinical variables associated with the occurrence of CSWs (p = .044, p = .001, and p < .001, respectively). Based on the logistic regression, the presence of infection (p < .001; OR = 90.8; 95% CI [18.42, 538.79]) persisted as a predictor of the occurrence of CSWs. From these observations, recommendations regarding best practices for the prevention of CSWs are made, specifically for patients with cancer.
Bioimpedance spectroscopy is currently used to evaluate patients with breast cancer-related lymphedema (BCRL). We aimed to describe published studies on the use of bioimpedance spectroscopy for assessment for BCRL. We qu...Bioimpedance spectroscopy is currently used to evaluate patients with breast cancer-related lymphedema (BCRL). We aimed to describe published studies on the use of bioimpedance spectroscopy for assessment for BCRL. We queried the PubMed, Ovid Medline, and Embase databases to identify studies that evaluated the use of bioimpedance spectroscopy as an assessment tool. We searched for the keywords "bioimpedance" AND ("lymphedema" OR "lymphoedema"). We included English-language studies that reported the use of bioimpedance spectroscopy for assessment of BCRL. Out of 152, 116, and 235 articles identified in each database, respectively, only a total of 11 articles were included. Bioimpedance spectroscopy was studied as a method to assess and predict response to BCRL treatment, assess volume changes, and calibrate L-Dex scores for conversion to units of volume. All studies reported that bioimpedance spectroscopy is a promising tool for predicting response to BCRL treatment and measuring volume changes. Bioimpedance spectroscopy can be used for assessment of BCRL. However, the accuracy of bioimpedance spectroscopy for BCRL assessment has not been determined, and consequently further studies are needed.
There are few studies comparing methods for pilonidal cyst closure. This study was conducted to compare simple surgical closure, secondary healing, and closure using a Limberg flap in the treatment of patients affected w...There are few studies comparing methods for pilonidal cyst closure. This study was conducted to compare simple surgical closure, secondary healing, and closure using a Limberg flap in the treatment of patients affected with pilonidal cysts. In total, 150 patients with pilonidal cysts were selected and randomized into 3 groups, with 50 participants in each group. Group A underwent primary closure, Group B underwent secondary closure, and Group C underwent closure with a Limberg flap. Operating time, amount of pain after surgery, time to mobilization, time until return to work, time for complete healing, time until being able to sit on the toilet without pain, postoperative complications including infection and recurrence, and seroma and edema after surgery were compared among the 3 groups. Duration of surgery in the Limberg flap group was significantly longer than the duration of surgery in Group A or Group B (p < .001). The time to patient mobilization, the time when the patient returned to work, the time to complete healing, and the time to being able to sit on the toilet without pain were significantly shorter in Group C than in Group A or Group B (p < .001). Although the procedure takes longer when using a Limberg flap, it appears to be a more effective method in the surgical treatment of patients with pilonidal cyst because of the reduced healing time and improved functional status after the procedure.
In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing h...In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.
Platelet-rich plasma (PRP) therapy is a new approach in dermatology and there is evidence to suggest that it provides excellent adjuvant treatment for nonscarring alopecia cases. There is evidence supporting the hypothes...Platelet-rich plasma (PRP) therapy is a new approach in dermatology and there is evidence to suggest that it provides excellent adjuvant treatment for nonscarring alopecia cases. There is evidence supporting the hypothesis that PRP therapy increases hair growth and thickness in patients with nonscarring alopecia. Studies including participants with scarring alopecia are limited and larger scale studies with tighter controls in PRP preparation, administration, and follow-up are needed to determine whether this is a clinically sound approach. Further symptom control analysis is also warranted as in both single and combination PRP therapy trials there are little data to support treatment effect on symptoms such as burning and itching. In this article, the author explains PRP preparation processes and PRP types and compares stand-alone PRP therapy with combination PRP study results. The author also makes recommendations for treatment and discusses the future of PRP research.
Many health care issues generate minimal passion, promoting benign commentary and support from the various stakeholders involved. Stem cell research does not fall into this category, and on the contrary, embryonic stem c...Many health care issues generate minimal passion, promoting benign commentary and support from the various stakeholders involved. Stem cell research does not fall into this category, and on the contrary, embryonic stem cell (ESC) research has continued to foster controversy and emotion. Since 1998, which marked the first successful laboratory isolation of ESCs, this research continues to ignite moral, ethical, and legal debate over its efficacy. The focus of this policy analysis is to introduce the issues, examine and address the various perspectives that surround ESC research, and present policy options and/or solutions that may be used to successfully create a policy consensus regarding this much debated topic.
AbobotulinumtoxinA (Dysport) has a long history as a safe and effective treatment option for aesthetic rejuvenation. One of the key measures of botulinum toxin efficacy is the persistence of clinically meaningful results...AbobotulinumtoxinA (Dysport) has a long history as a safe and effective treatment option for aesthetic rejuvenation. One of the key measures of botulinum toxin efficacy is the persistence of clinically meaningful results. The duration of efficacy depends on different factors, many of which can be controlled by the clinician to better achieve their desired results. In this review, we discuss how dose, individual patient variation, and injection technique affect the duration of botulinum toxins. Increased duration may result from increased dose or more precise placement of the toxin in the muscle. The varying anatomy and behavior of patients can affect duration as well. Measures of duration in clinical studies vary, but both a 1-grade improvement on the glabellar line severity scale and patient-reported outcomes are key measures. The clinical effects of Dysport can last up to 5 months, and patients in Dysport clinical studies remained satisfied with treatment for up to 6 months. Dysport has a legacy of safety, efficacy, and high subject satisfaction demonstrated through studies and clinical experience. Building on that legacy by correctly dosing the subject, properly accounting for the individual subject anatomy and behavior, and using specific injection techniques can help ensure that your patients have the longest lasting results.
Excess breast volume can lead to changes in the postural pattern that may result in pain. This causes women to seek reduction mammaplasty, a surgical procedure that reduces breast volume and may provide relief from sympt...Excess breast volume can lead to changes in the postural pattern that may result in pain. This causes women to seek reduction mammaplasty, a surgical procedure that reduces breast volume and may provide relief from symptoms. The objective of this study was to evaluate whether reduction mammaplasty can influence the posture of women. The postures of women with breast hypertrophy were evaluated using postural assessment software and photographic recording performed on the day of surgery and 3 months after the procedure. After surgical breast reduction, the patients had statistically significant changes in their postural patterns related to the horizontal alignment of the anterosuperior iliac spines and the angle of the acromion and anterior superior iliac spines. The analysis of the results showed statistically significant data on postural changes in the patients 3 months after the surgical procedure.
In this article, we describe the case of a patient suffering from middle-third helical rim avulsion after a bicycle accident, which was reconstructed with a two-stage procedure: (1) performing a postauricular pedicled fl...In this article, we describe the case of a patient suffering from middle-third helical rim avulsion after a bicycle accident, which was reconstructed with a two-stage procedure: (1) performing a postauricular pedicled flap and (2) reconstruction using a costal graft. The article also includes a brief summary of recommendations in the scientific literature about the reconstruction of middle-third auricular defects.
Stereotypes of older adults and assumptions of old age as a time of dependency and vulnerability affect not only how older adults are perceived and treated by society, but how they are treated by members of the nursing p...Stereotypes of older adults and assumptions of old age as a time of dependency and vulnerability affect not only how older adults are perceived and treated by society, but how they are treated by members of the nursing profession as well. When nurses display ageist attitudes, it can be harmful to older patients both physically and emotionally. In this review article the author describes some of the literature related to ageism in nursing, discusses how ageism can affect the quality of the care that is provided to older adult patients, and explains theories that may help explain ageism in nursing.
In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alope...In this article, the author focuses on 4 common hair loss disorders that occur in both men and women. The author discusses research related to androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia and provides details on how to approach and manage these diseases according to patient gender. There are a range of tools and tests that can assist with the diagnostic process and help ensure that relevant and high standards of patient care are maintained. In some cases, no medical intervention is always a treatment option. However, appropriate medical treatments, although still relatively limited in some cases, are safe and have proven efficacy. Hair loss has immense emotional and psychological impact in both genders, and it is always important to consider this when planning hair loss management pathways.
As skin cancer prevalence continues to rise, the importance of sun protection, including sunscreen use, has become accepted in the public. Sunscreens are divided into two main categories based on the type of their active...As skin cancer prevalence continues to rise, the importance of sun protection, including sunscreen use, has become accepted in the public. Sunscreens are divided into two main categories based on the type of their active ingredient, organic and inorganic ultraviolet (UV) filters. It has been shown that inorganic filters are more effective at blocking forms of UV light, both UVA and UVB, as compared with organic filters because organic sunscreens absorb and convert radiation whereas inorganic sunscreens reflect radiation. The use of the two most common organic filters, oxybenzone and octinoxate, has recently been restricted in Hawaii due to their harmful effect on the coral reefs. Here, we discuss recent studies about these specific filters related to the adverse health risks they pose for humans and other organisms, as well as environmental repercussions.
With the increasing interest in nonsurgical cosmetic procedures, this research study sought to evaluate the onset of Botulinum toxin Type A (BoNTA) between naive and non-naive consumers and its effect on satisfaction. Th...With the increasing interest in nonsurgical cosmetic procedures, this research study sought to evaluate the onset of Botulinum toxin Type A (BoNTA) between naive and non-naive consumers and its effect on satisfaction. This single-blinded research study consisted of 15 adults with scheduled appointments for neurotoxin treatment of undesired glabellar lines. Participants completed pretreatment FACE-Q scales. Both the participant and the researcher rated pretreated glabellar lines with the Merz 5-point scale. Daily photographs of the treated area were taken by the participant and submitted to the researcher over a secure electronic system. Photographs were started on the treatment day and continued until both participant- and researcher-reported onset. The day of onset was determined with at least 1-point improvement when observed by both the participant and the researcher on the Merz 5-point scale. Once onset was determined, participants completed posttreatment FACE-Q scales. The average onset of treatment was 2.3 days. The average day of onset was 1.8 days in the naive group and 2.65 days in the non-naive group. Posttreatment, patients reported an average of 47.65% reduction in the appearance of glabellar lines; a 35.65% reduction was reported in the non-naive group, and a 59.67% reduction was reported in the naive group. The average participants perceived themselves 2.07 years younger prior to treatment and 6.47 years younger than their actual age posttreatment. On average, participants perceived themselves 4.4 years younger than at baseline. Both groups reported a high level of satisfaction with decision at an average of 85.73% and an average of 86.20% on satisfaction with outcome. The posttreatment FACE-Q expectation scores on average exceeded the pretreatment expectation scores by 8.25%; in the naive group, the scores were exceeded by 25.54%. The onset of BoNTA treatment in naive and non-naive participants demonstrated differences. The naive group experienced onset, on average, 1 day sooner than the non-naive group. The amount of time for a participant to see a noticeable difference influences patient satisfaction. Improvements in appearance and a reduction in the appraisal of age in relation to actual age enhanced satisfaction with treatment. Findings indicate that satisfaction is not solely based on onset, improvements in appearance, and reports of looking younger. The patient perception is also a key factor affecting satisfaction, which can be improved by setting clear expectations, improving patient communication, and encouraging follow-up assessments. The need for additional research on naive and non-naive patients demonstrating the influence of onset on satisfaction scores is crucial to confirm the evidence of this study.